Impact of independent scrutiny on the death certification process in England and Wales

Introduction of the statutory process of independent medical scrutiny in England and Wales, provides an excellent opportunity to identify shortfalls, concerns and helps us to learn from deaths. The system adopted by Wales (in contrast to England) guarantees fully independent scrutiny as recommended by the confidential enquiries into deaths. Evidence shows that a significant proportion of deaths has been referred to the care providers for a clinical review and to improve patient care. However, the system has created so many steps in the death certification process it leads to delays in issuing death certificates causing distress and anguish to the bereaved families. A multipronged approach to streamline the death certification process should include: education and training of doctors, a prompt, proportionate and pragmatic scrutiny by MEs, a review of the criteria for referral to coroners, implementation of digital MCCD and an overhaul of the list of causes of death.